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Annual report of the Bureau of Vital Statistics of the North Carolina State Board of Health

THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
This book may be kept out one month unless a recall
notice is sent to you. It must be brought to the North
Carolina Collection (in Wilson Library) for renewal.
Form No. A-369
Digitized by the Internet Archive
in 2009 with funding from
Ensuring Democracy through Digital Access (NC-LSTA)
http://www.archive.org/details/annualreportofpu19591nort
.:^y
ANNUAL REPORT
F
PUBLIC HEALTH
STATISTICS SECTION
PART I
COMMUNICABLE DISEASE
MORBIDITY STATISTICS
1959
NORTH CAROLINA STATE BOARD OF HEALTH
EPIDEMIOLOGY DIVISION
.^v,{V-
ANNUAL REPORT
F
PUBLIC HEALTH
STATISTICS SECTION
PART I
COMMUNICABLE DISEASE
MORBIDITY STATISTICS
1959
NORTH CAROLINA STATE BOARD OF HEALTH
EPIDEMIOLOGY DIVISION
J.W. R. NORTON, M. D.
Secretory
and State Health Director
i^
TABLE OF CONTENTS
Page
Introduction 1
TABLES
1. Estimated Population by Color: North Carolina and Each County, July 1, M59 3
2. Estimated Population by Color and Sex: North Carolina, 1936-1959 4
3. Cases of Reportable Communicable Diseases by Disease and Year of Report: North
Carolina, 1918-1959 5
4. Morbidity Rates Per 100,000 Population for Selected Reportable Communicable Diseases
by Disease and Year of Report: North Carolina, 1944-1959 9
5. Cases of Reportable Communicable Diseases by Disease and County of Residence: North
Carolina, 1959 10
6. Cases of Reportable Communicable Diseases by Disease and Month of Onset: North
Carol ina, 1959 24
7. Cases of Reportable Communicable Diseases by Disease and Age: North Carolina, 1959.. 25
8. Cases of Reportable Communicable Diseases by Disease, Color, and Sex with Rates Per
100,000 Population: North Carolina, 1959 26
9. Cases of Qastro-enteritis by County of Residence, Type, and Color: North Carolina,
1959 28
10. Cases of Previously Untreated Gonorrhea by County of Report, Type, Color, and Sex:
North Carolina, 1959 31
11. Cases of Infectious Jaundice by County of Residence, Type, and Color: North
Carolina, 1959 35
12. Cases of Poliomyelitis by County of Residence, Color, Paralytic Status, and Month of
Onset: North Carolina, 1959 36
13. Cases of Previously Untreated Syphilis by County of Report, Stage, Color, and Sex:
North Carolina, 1959 38
14. Cases of Previously Untreated Syphilis by Stage, Color, and Sex with Rates Per
100, 000 Population: North Carolina, 1940, 1950, and 1959 41
15. Cases of Previously Untreated Congenital Syphilis by Year of Birth, Year of Report,
and Color: North Carolina, 1952-1959 42
16. Cases of Tuberculosis, All Forms, by County of Residence, Type, Stage, Activity, and
Color: North Carolina, 1959 44
V
INTRODUCTION
Communicable disease morbidity statistics for North Carolina for 1959 are given in this bulletin as
Part I of the Annual Report of the Public Health Statistics Section. This is the twenty-eighth year for
which such a bulletin has been published. Natality and mortality data will be published as Part II later
in the year.
A discussion summary of the reportable communicable disease situation in the state is given on the next
page. Following this are population estimates andgeneral simmary tables showing the reported incidence of
reportable communicable diseases in 1959 by county, age, month of onset, sex, and color. More detailed
stimmaries are also given for certain selected diseases.
SOURCE OF DATA
These data were derived from report cards received from military bases, local physicians, health de-partments,
and hospitals in North Carolina, and through interstate reciprocal notification of disease.
Routinely all death certificates which list a reportable communicable disease as a cause of death are checked
against the case report files. Case reports are then obtained for all previously unreported cases. Infor-mation
on trends may be obtained by reference to the 1953 report. More detailed data than that published
in this report have been tabulated and will be made available upon request.
REPORT PERIOD
The data included in this report are for cases of communicable disease which had their onset in 1959
with the exception of amebiasis, leprosy, tuberculosis, and the venereal diseases which are according to
the date of report. Reports of all cases having their onset in 1959 and received during the period January 1,
1959 to January 31, 1960 and those with unknown date of onset received in 1959 are included. For those
diseases tabulated by date of report, all reports received during 1959 are included, regardless of onset
date.
RESIDENCE
The cases included in this report, with the exception of the venereal diseases, are for residents of
North Carolina and are allocated to county of residence of the patient. Venereal disease cases are allocated
to county of report unless reported by a hospital or institution; in which case they are assigned to the
county of residence. Only those counties for which cases were reported are shown in the residence tables.
RATES
All rates shown are per 100,000 population. A 16-year trend inmorbidity rates for selected reportable
comm\inicable diseases is shown in table 4. Rates for 1959 by sex and color for all reportable diseases
are given in table 8.
POPULATION
North Carolina population estimates by county and color, 1959 and by color and sex, 1936-1959 are
given in tables 1 and 2, respectively.
Population estimates for 1936-1950 are those prepared by the U. S. Bureau of the Census. For the
years 1951-1959, estimates were made by the Public Health Statistics Section. The arithmetic method, which
assumes the same average annual increase or decrease for the decade 1950-1960 as occurred between 1940 and
1950, was used for estimating the total population. Sex and color estimates were obtained by this same
method.
DISCUSSION
In general, the 1959 communicable disease experience showed a favorable trend in case control. Epi-demic
influenza did not occur during the year. Some infections, known or suspected to occur in a cyclic
fashion, showed increases or decreases in case incidences as expected from prior years' experience.
Twenty-two cases of amebiasis were reported. Diagnosis generally reflected presence of interested
physicians and laboratory workers. As in other states it may be assumed that actual number of infections
far exceed the number of cases reported.
For the third successive year no case of anthrax was reported. A number of factors have served to
limit anthrax since the cluster of nine cases seen in 1953-1956. Continuous control efforts through health
and agriculture agencies to sterilize contaminated materials, improve plant sanitation, and provide close
health supervision play an important role in elimination of the industrial anthrax hazard.
Cases of diphtheria in 1959 fell to the lowest level. 20cases, since reporting was initiated. Widespread
immunization programs of private physicians and healtn departments have been highly effective in control
of this disease. A high proportion of cases are laboratory confirmed; in 1959 all strains isolated were
of the mitis type. An equal number of cases (10) occurred in the white and nonwhite groups. The overall
case rate per 100,000 population was 0.4; in whites, the rate was 0.3 and in nonwhites, 0.9. Twelve cases
were seen in children under 9 years of age; all but two cases occurred in persons aged 19 and under. Pour
counties contributed two cases each accounting for eight of the twenty cases reported.
There were thirty^six oases of encephalitis reported in 1959 compared with 53 the previous year. Of
the 36 cases, none was serologically established as due to the known arthropod borne agents. _ A number may
be related to as yet undiscovered viral agents and a number are related to earlier virus infections. Measles
is frequently implicated in this situation — post-measles encephalitis. Eastern encephalitis virus was
present in the State as demonstrated in studies of horses, mules, and pheasants. So far as can be de-termined,
however, the virus did not spill over into the human population.
For the past four years the number of cases of gastro-enteritis has increased. This diagnostic cate-gory
receives much attention through intensive investigation of individual cases andgroup outbreaks carried
out by local health departments and the Division of Epidemiology. It is possible that the apparent increase
in cases represents a true rise in incidence. Also possible is that the number of cases recorded reflects
increased interest, intensified investigation and improving diagnostic facilities. Major problems, diffi-cult
to control, related to household and community sanitation, and animal-man disease transmission remains
to be solved before the number of cases can be substantially reduced.
After declining for five years, the niamber of cases of infectious hepatitis increased from a low 75
in 1958 to 118 in 1959. Presently unknown is the long term behavior of this disease category. It seems
certain, however, that case incidence occurs in a cyclic pattern with cycles of uneven length and height.
Experience in the next several years should clarify this picture. Absence of an agent pathogenic for other
than humans sharply limits effective study of the jaxmdice producing viral agents.
Only two cases of malaria were reported. One was of military origin; the other was reported from
Guilford County. Unfortunately, smears upon which diagnosis wasbased in the latter ease were not preserved.
Therailitary, as for the past decade, continues to supply eases of this now rare parasitic infection. All
military cases for many years have been extraterritorial in origin.
One case of leprosy was reported from Guilford County. An ex-serviceman, he contracted the disease
while abroad.
Of the more exotic human diseases attributable to origin in the animal world five types were not seen
in 1959: glanders. leptospirosis, psittacosis, rabies and trichinosis. On the other hand, a case of Q-fever
was recorded. Tne patient was an adult male showing typical symptoms. Diagnosis was confirmed by se-rological
studies.
Poliomyelitis was intensively investigated with individual case follow-up of all cases through local
health departments and the Communicable Disease Control Section. Experience in 1959 was in sharp contrast
to 1958 when a low point was reached in a five-year cycle which saw cases decline from 926 in 1953 to 74 in
1958. A rise incases reported (313) for 1959 was noted with 270 of these paralytic in type. Type I polio
virus—the epidemic type—was repeatedly isolated; some type 3 but no type 2 strains were isolated in North
Carolina. Twenty-one persons died as a result of the 1959 outbreak, two occurring in 1960. The impact of
this disease upon the nonimmunized, especially those under five years of age, and the gradually increasing
case rate among the State's nonwhite population were outstanding extensions of the trends seen for the past
several years. One hundred sixty-six cases were seen in children under five years of age. Thirty-seven
cases occurred in individuals aged 20 or over. Of this latter group, ten individuals died, emphasizing
the virulence of the disease when it occurs in adults. Illness in whites accounted for 184 cases, a rate
of 5.5 per 100,000 population; illness in nonwhites accounted for 129 cases, a rate of 11.2 per 100,000
population. Of 270 paralytic cases, 168 had received no poliomyelitis vaccine. Peak of illness was seen
in August and September.
Twenty-four cases of Rocky Mountain spotted fever were reported, a decrease of one case from the
previous year. Case numbers have varied from 24 to 40 in the past eight years. As might be expected from
the pattern of transmission from tick to human, the bulk of cases were seen in the May-August interval when
22 of the 24 cases occurred. Those under age 10 accounted for 11 cases, the 10-19 age group numbered 10
cases, and adults accounted for only three cases. Two-thirds of the cases, i.e., 16 of 24, were found in
males. Age and sex distribution are in keeping with the greater likelihood of males' tick contact and the
fact that lack of awareness and failure to remove ticks in the case of children probably dictates age
distribution.
Streptococcal infections (scarlet fever and septic sore throat) have shown little change for the past
several years. Fortunately infections appear to have become more mild over a period of perhaps 70 years.
Unfortunately, infections which occur are still serious and lead to a fearful toll of such post-streptococcal
complications as acute rheumatic fever and acute glomerulonephritis when untreated. Emphasis on early,
vigorous, and specific treatment must continue if late spquelae of these common infections are to be reduced.
Cases of tuberculosis fell slightly below the number reported in 1958. The case rate, 32.0 per 100,000
population, is the lowest yet recorded. The case rate in whites was 20.8; in nonwhites it was 64.9. Males
showed a case rate per 100,000 population of 39.2, females 24.9.
Only seven cases of tularemia were noted. Six occurred during the small game season, November
—
February; five occurred in males and two in females.
Incidence of typhoid fever has been essentially unchanged in the past four years. Eighteen cases were
reported in 1959. Cases recorded were found in each month with exception of March, April, and November.
In present day single carriei^single case relationship, a seasonal distribution is seldom noted. Six cases
were in the 0-9 age group, 8 in the 10-19 interval, and the remaining four cases were found in adults.
Whites numbered 10 cases, nonwhites 8 cases.
Whooping cough occurred in greater and measles inlesser number than in the previous year. Occurrence
of each could be explained on the known cyclic behavior of these illnesses. Each, however, is open to
immunological, approach. Cases of whooping cough could be further reduced and deaths prevented by more
widespread acceptance of pertussis vaccine. While measles can be prevented or modified by use of gamma
globulin following known exposure, it may be expected that measles vaccines presently under study will pro-vide
better answers t'o measles control.
Only fo\ir cases of undulant fever were brought to light. Each was laboratory confirmed by culture,
serology or both. Three of the 4 cases occurred inpersons over age 29 and three were seen in males, empha-sizing
the usual sex and age distribution in this State.
Cases of venereal disease fell slightly from 16,586 (1958) to 15,239 (1959). The decline noted was
largely due to a slight reduction in numbers of cases of gonorrhea reported. Essentially unchanged were
numbers of cases of syphilis and ophthalmia neonatorum. Primary-Secondary syphilis made up 207 cases of
which 170 were nonwhite; 37 were white. Need for vigorous epidemiological follow-up is apparent, especially
when it is recalled that cases of syphilis counted reflect untreated disease and that the 207 cases of
primary-secondary syphilis represent the stage of infection during which transmission usually takes place.
The 207 cases of early infection showed a decline from 251 such cases in 1958. Cases of untreated con-genital
syphilis numbered 251 in comparison with 197 in 1958. Many were of long standing before diagnosis
was definitely established. It is encouraging that only eight cases were recorded as having onset in 1959.
Ten such cases occurred in 1957 and five in 1958. Venereal disease remains an important part of communi-cable
disease control.
Symbols Used in Tables
- Number or rate is zero
/ Disease was not reportable
N.A. Data was not available
0.0. Rate is more than but less than 0.05
ANNUAL REPORT OF MORBIDITY STATISTICS
ESTIMATED POPULATION BY COLOR: NORTH CAROLINA AND EACH COUNTY, JULY
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
CASES OF REPORTABLE COMMUNICABLE DISEASES BY DISEASE AND YEAR OF REPORT*:
NORTH CAROLINA, 1918- 1959
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 3. -- COMMUNICABLE DISEASES --
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. -- CASES OF REPORTABLE COMMUNICABLE DISEASES BY
DISEASE AND COUNTY OF RESIDENCE*: NORTH CAROLINA, 1959
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
COMMUNICABLE DISEASES — Continu
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES ~ Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. ~ COMMUNICABLE DISEASES - Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
COKt'lUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — COMMUNICABLE DISEASES ~ Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
ANKUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. -- CONWUNICABLE DISEASES -- Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. ~ COMMUNICABLE DISEASES ~ Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. ~ COMMUNICABLE DISEASES
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. ~ COMMUNICABLE DISEASES — Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
^2
•
X)
-D <U
c —
i
II
ANNUAL REPOliT OF MORBIDITY STATISTICS
TABLE II. — CASES OF INFECTIOUS JAUNDICE' BY COUNTY OF RESIDENCE,
TYPE, AND COLOR: NORTH CAROLINA, 1959
Area
1
o
1
'
NORTH CAROLINA STATE BOARD OF HEALTH
OOCO^OlDLf) ID r~ CM — to
lO — CM I zl-
CJ) I —CMC
CM <OC
r-OLOcNO
CM —
in in CM 01 d-lo
— Lor-—coin
in ooinm
<<i<i-<«3:
J 1- 3 0) (U
30000 00000
h-
NORTH CAROLINA STATE BOARD OF HEALTH
—o mc
irtm
csinuaooc
CM I I
-tOLr):±|^ ^DcMcv<£)=^ -uacMCMui l-«NC\J I 00
f^ I =f — t CN4D O
Olor^OiLO CM a> CM LOCO
g o ra o 1 ^ — -o c
(0 <0
(U
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 15. — CASES OF PREVIOUSLY UNTREATED CONGENITAL
NORTH CAROLINA,
ANNUAL REPORT OF MORBIDITY STATISTICS
SYPHILIS BY YEAR OF BIRTH, YEAR OF REPORT, AND COLOR:
1952-1959
1956
NORTH CAROLINA STATE BOARD OF HEALIH
TABLE 16. - CASES OF TUBERCULOSIS, ALL FORMS, BY COUNTY OF
ANNUAL REPORT OF MORBIDITY STATISTICS
RESIDENCE, TYPE, STAGE, ACTIVITY, AND COLOR: NORTH CAROLINA, 1959
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
TUBERCULOSIS -- Continued
^ I3?-;?'i}^

THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
This book may be kept out one month unless a recall
notice is sent to you. It must be brought to the North
Carolina Collection (in Wilson Library) for renewal.
Form No. A-369
Digitized by the Internet Archive
in 2009 with funding from
Ensuring Democracy through Digital Access (NC-LSTA)
http://www.archive.org/details/annualreportofpu19591nort
.:^y
ANNUAL REPORT
F
PUBLIC HEALTH
STATISTICS SECTION
PART I
COMMUNICABLE DISEASE
MORBIDITY STATISTICS
1959
NORTH CAROLINA STATE BOARD OF HEALTH
EPIDEMIOLOGY DIVISION
.^v,{V-
ANNUAL REPORT
F
PUBLIC HEALTH
STATISTICS SECTION
PART I
COMMUNICABLE DISEASE
MORBIDITY STATISTICS
1959
NORTH CAROLINA STATE BOARD OF HEALTH
EPIDEMIOLOGY DIVISION
J.W. R. NORTON, M. D.
Secretory
and State Health Director
i^
TABLE OF CONTENTS
Page
Introduction 1
TABLES
1. Estimated Population by Color: North Carolina and Each County, July 1, M59 3
2. Estimated Population by Color and Sex: North Carolina, 1936-1959 4
3. Cases of Reportable Communicable Diseases by Disease and Year of Report: North
Carolina, 1918-1959 5
4. Morbidity Rates Per 100,000 Population for Selected Reportable Communicable Diseases
by Disease and Year of Report: North Carolina, 1944-1959 9
5. Cases of Reportable Communicable Diseases by Disease and County of Residence: North
Carolina, 1959 10
6. Cases of Reportable Communicable Diseases by Disease and Month of Onset: North
Carol ina, 1959 24
7. Cases of Reportable Communicable Diseases by Disease and Age: North Carolina, 1959.. 25
8. Cases of Reportable Communicable Diseases by Disease, Color, and Sex with Rates Per
100,000 Population: North Carolina, 1959 26
9. Cases of Qastro-enteritis by County of Residence, Type, and Color: North Carolina,
1959 28
10. Cases of Previously Untreated Gonorrhea by County of Report, Type, Color, and Sex:
North Carolina, 1959 31
11. Cases of Infectious Jaundice by County of Residence, Type, and Color: North
Carolina, 1959 35
12. Cases of Poliomyelitis by County of Residence, Color, Paralytic Status, and Month of
Onset: North Carolina, 1959 36
13. Cases of Previously Untreated Syphilis by County of Report, Stage, Color, and Sex:
North Carolina, 1959 38
14. Cases of Previously Untreated Syphilis by Stage, Color, and Sex with Rates Per
100, 000 Population: North Carolina, 1940, 1950, and 1959 41
15. Cases of Previously Untreated Congenital Syphilis by Year of Birth, Year of Report,
and Color: North Carolina, 1952-1959 42
16. Cases of Tuberculosis, All Forms, by County of Residence, Type, Stage, Activity, and
Color: North Carolina, 1959 44
V
INTRODUCTION
Communicable disease morbidity statistics for North Carolina for 1959 are given in this bulletin as
Part I of the Annual Report of the Public Health Statistics Section. This is the twenty-eighth year for
which such a bulletin has been published. Natality and mortality data will be published as Part II later
in the year.
A discussion summary of the reportable communicable disease situation in the state is given on the next
page. Following this are population estimates andgeneral simmary tables showing the reported incidence of
reportable communicable diseases in 1959 by county, age, month of onset, sex, and color. More detailed
stimmaries are also given for certain selected diseases.
SOURCE OF DATA
These data were derived from report cards received from military bases, local physicians, health de-partments,
and hospitals in North Carolina, and through interstate reciprocal notification of disease.
Routinely all death certificates which list a reportable communicable disease as a cause of death are checked
against the case report files. Case reports are then obtained for all previously unreported cases. Infor-mation
on trends may be obtained by reference to the 1953 report. More detailed data than that published
in this report have been tabulated and will be made available upon request.
REPORT PERIOD
The data included in this report are for cases of communicable disease which had their onset in 1959
with the exception of amebiasis, leprosy, tuberculosis, and the venereal diseases which are according to
the date of report. Reports of all cases having their onset in 1959 and received during the period January 1,
1959 to January 31, 1960 and those with unknown date of onset received in 1959 are included. For those
diseases tabulated by date of report, all reports received during 1959 are included, regardless of onset
date.
RESIDENCE
The cases included in this report, with the exception of the venereal diseases, are for residents of
North Carolina and are allocated to county of residence of the patient. Venereal disease cases are allocated
to county of report unless reported by a hospital or institution; in which case they are assigned to the
county of residence. Only those counties for which cases were reported are shown in the residence tables.
RATES
All rates shown are per 100,000 population. A 16-year trend inmorbidity rates for selected reportable
comm\inicable diseases is shown in table 4. Rates for 1959 by sex and color for all reportable diseases
are given in table 8.
POPULATION
North Carolina population estimates by county and color, 1959 and by color and sex, 1936-1959 are
given in tables 1 and 2, respectively.
Population estimates for 1936-1950 are those prepared by the U. S. Bureau of the Census. For the
years 1951-1959, estimates were made by the Public Health Statistics Section. The arithmetic method, which
assumes the same average annual increase or decrease for the decade 1950-1960 as occurred between 1940 and
1950, was used for estimating the total population. Sex and color estimates were obtained by this same
method.
DISCUSSION
In general, the 1959 communicable disease experience showed a favorable trend in case control. Epi-demic
influenza did not occur during the year. Some infections, known or suspected to occur in a cyclic
fashion, showed increases or decreases in case incidences as expected from prior years' experience.
Twenty-two cases of amebiasis were reported. Diagnosis generally reflected presence of interested
physicians and laboratory workers. As in other states it may be assumed that actual number of infections
far exceed the number of cases reported.
For the third successive year no case of anthrax was reported. A number of factors have served to
limit anthrax since the cluster of nine cases seen in 1953-1956. Continuous control efforts through health
and agriculture agencies to sterilize contaminated materials, improve plant sanitation, and provide close
health supervision play an important role in elimination of the industrial anthrax hazard.
Cases of diphtheria in 1959 fell to the lowest level. 20cases, since reporting was initiated. Widespread
immunization programs of private physicians and healtn departments have been highly effective in control
of this disease. A high proportion of cases are laboratory confirmed; in 1959 all strains isolated were
of the mitis type. An equal number of cases (10) occurred in the white and nonwhite groups. The overall
case rate per 100,000 population was 0.4; in whites, the rate was 0.3 and in nonwhites, 0.9. Twelve cases
were seen in children under 9 years of age; all but two cases occurred in persons aged 19 and under. Pour
counties contributed two cases each accounting for eight of the twenty cases reported.
There were thirty^six oases of encephalitis reported in 1959 compared with 53 the previous year. Of
the 36 cases, none was serologically established as due to the known arthropod borne agents. _ A number may
be related to as yet undiscovered viral agents and a number are related to earlier virus infections. Measles
is frequently implicated in this situation — post-measles encephalitis. Eastern encephalitis virus was
present in the State as demonstrated in studies of horses, mules, and pheasants. So far as can be de-termined,
however, the virus did not spill over into the human population.
For the past four years the number of cases of gastro-enteritis has increased. This diagnostic cate-gory
receives much attention through intensive investigation of individual cases andgroup outbreaks carried
out by local health departments and the Division of Epidemiology. It is possible that the apparent increase
in cases represents a true rise in incidence. Also possible is that the number of cases recorded reflects
increased interest, intensified investigation and improving diagnostic facilities. Major problems, diffi-cult
to control, related to household and community sanitation, and animal-man disease transmission remains
to be solved before the number of cases can be substantially reduced.
After declining for five years, the niamber of cases of infectious hepatitis increased from a low 75
in 1958 to 118 in 1959. Presently unknown is the long term behavior of this disease category. It seems
certain, however, that case incidence occurs in a cyclic pattern with cycles of uneven length and height.
Experience in the next several years should clarify this picture. Absence of an agent pathogenic for other
than humans sharply limits effective study of the jaxmdice producing viral agents.
Only two cases of malaria were reported. One was of military origin; the other was reported from
Guilford County. Unfortunately, smears upon which diagnosis wasbased in the latter ease were not preserved.
Therailitary, as for the past decade, continues to supply eases of this now rare parasitic infection. All
military cases for many years have been extraterritorial in origin.
One case of leprosy was reported from Guilford County. An ex-serviceman, he contracted the disease
while abroad.
Of the more exotic human diseases attributable to origin in the animal world five types were not seen
in 1959: glanders. leptospirosis, psittacosis, rabies and trichinosis. On the other hand, a case of Q-fever
was recorded. Tne patient was an adult male showing typical symptoms. Diagnosis was confirmed by se-rological
studies.
Poliomyelitis was intensively investigated with individual case follow-up of all cases through local
health departments and the Communicable Disease Control Section. Experience in 1959 was in sharp contrast
to 1958 when a low point was reached in a five-year cycle which saw cases decline from 926 in 1953 to 74 in
1958. A rise incases reported (313) for 1959 was noted with 270 of these paralytic in type. Type I polio
virus—the epidemic type—was repeatedly isolated; some type 3 but no type 2 strains were isolated in North
Carolina. Twenty-one persons died as a result of the 1959 outbreak, two occurring in 1960. The impact of
this disease upon the nonimmunized, especially those under five years of age, and the gradually increasing
case rate among the State's nonwhite population were outstanding extensions of the trends seen for the past
several years. One hundred sixty-six cases were seen in children under five years of age. Thirty-seven
cases occurred in individuals aged 20 or over. Of this latter group, ten individuals died, emphasizing
the virulence of the disease when it occurs in adults. Illness in whites accounted for 184 cases, a rate
of 5.5 per 100,000 population; illness in nonwhites accounted for 129 cases, a rate of 11.2 per 100,000
population. Of 270 paralytic cases, 168 had received no poliomyelitis vaccine. Peak of illness was seen
in August and September.
Twenty-four cases of Rocky Mountain spotted fever were reported, a decrease of one case from the
previous year. Case numbers have varied from 24 to 40 in the past eight years. As might be expected from
the pattern of transmission from tick to human, the bulk of cases were seen in the May-August interval when
22 of the 24 cases occurred. Those under age 10 accounted for 11 cases, the 10-19 age group numbered 10
cases, and adults accounted for only three cases. Two-thirds of the cases, i.e., 16 of 24, were found in
males. Age and sex distribution are in keeping with the greater likelihood of males' tick contact and the
fact that lack of awareness and failure to remove ticks in the case of children probably dictates age
distribution.
Streptococcal infections (scarlet fever and septic sore throat) have shown little change for the past
several years. Fortunately infections appear to have become more mild over a period of perhaps 70 years.
Unfortunately, infections which occur are still serious and lead to a fearful toll of such post-streptococcal
complications as acute rheumatic fever and acute glomerulonephritis when untreated. Emphasis on early,
vigorous, and specific treatment must continue if late spquelae of these common infections are to be reduced.
Cases of tuberculosis fell slightly below the number reported in 1958. The case rate, 32.0 per 100,000
population, is the lowest yet recorded. The case rate in whites was 20.8; in nonwhites it was 64.9. Males
showed a case rate per 100,000 population of 39.2, females 24.9.
Only seven cases of tularemia were noted. Six occurred during the small game season, November
—
February; five occurred in males and two in females.
Incidence of typhoid fever has been essentially unchanged in the past four years. Eighteen cases were
reported in 1959. Cases recorded were found in each month with exception of March, April, and November.
In present day single carriei^single case relationship, a seasonal distribution is seldom noted. Six cases
were in the 0-9 age group, 8 in the 10-19 interval, and the remaining four cases were found in adults.
Whites numbered 10 cases, nonwhites 8 cases.
Whooping cough occurred in greater and measles inlesser number than in the previous year. Occurrence
of each could be explained on the known cyclic behavior of these illnesses. Each, however, is open to
immunological, approach. Cases of whooping cough could be further reduced and deaths prevented by more
widespread acceptance of pertussis vaccine. While measles can be prevented or modified by use of gamma
globulin following known exposure, it may be expected that measles vaccines presently under study will pro-vide
better answers t'o measles control.
Only fo\ir cases of undulant fever were brought to light. Each was laboratory confirmed by culture,
serology or both. Three of the 4 cases occurred inpersons over age 29 and three were seen in males, empha-sizing
the usual sex and age distribution in this State.
Cases of venereal disease fell slightly from 16,586 (1958) to 15,239 (1959). The decline noted was
largely due to a slight reduction in numbers of cases of gonorrhea reported. Essentially unchanged were
numbers of cases of syphilis and ophthalmia neonatorum. Primary-Secondary syphilis made up 207 cases of
which 170 were nonwhite; 37 were white. Need for vigorous epidemiological follow-up is apparent, especially
when it is recalled that cases of syphilis counted reflect untreated disease and that the 207 cases of
primary-secondary syphilis represent the stage of infection during which transmission usually takes place.
The 207 cases of early infection showed a decline from 251 such cases in 1958. Cases of untreated con-genital
syphilis numbered 251 in comparison with 197 in 1958. Many were of long standing before diagnosis
was definitely established. It is encouraging that only eight cases were recorded as having onset in 1959.
Ten such cases occurred in 1957 and five in 1958. Venereal disease remains an important part of communi-cable
disease control.
Symbols Used in Tables
- Number or rate is zero
/ Disease was not reportable
N.A. Data was not available
0.0. Rate is more than but less than 0.05
ANNUAL REPORT OF MORBIDITY STATISTICS
ESTIMATED POPULATION BY COLOR: NORTH CAROLINA AND EACH COUNTY, JULY
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
CASES OF REPORTABLE COMMUNICABLE DISEASES BY DISEASE AND YEAR OF REPORT*:
NORTH CAROLINA, 1918- 1959
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 3. -- COMMUNICABLE DISEASES --
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. -- CASES OF REPORTABLE COMMUNICABLE DISEASES BY
DISEASE AND COUNTY OF RESIDENCE*: NORTH CAROLINA, 1959
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
COMMUNICABLE DISEASES — Continu
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES ~ Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. ~ COMMUNICABLE DISEASES - Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
COKt'lUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — COMMUNICABLE DISEASES ~ Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
ANKUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. -- CONWUNICABLE DISEASES -- Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. ~ COMMUNICABLE DISEASES ~ Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. ~ COMMUNICABLE DISEASES
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. ~ COMMUNICABLE DISEASES — Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
^2
•
X)
-D CM LOCO
g o ra o 1 ^ — -o c
(0 <0
(U
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 15. — CASES OF PREVIOUSLY UNTREATED CONGENITAL
NORTH CAROLINA,
ANNUAL REPORT OF MORBIDITY STATISTICS
SYPHILIS BY YEAR OF BIRTH, YEAR OF REPORT, AND COLOR:
1952-1959
1956
NORTH CAROLINA STATE BOARD OF HEALIH
TABLE 16. - CASES OF TUBERCULOSIS, ALL FORMS, BY COUNTY OF
ANNUAL REPORT OF MORBIDITY STATISTICS
RESIDENCE, TYPE, STAGE, ACTIVITY, AND COLOR: NORTH CAROLINA, 1959
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
TUBERCULOSIS -- Continued
^ I3?-;?'i}^